1. Field of the Invention
The present invention relates to arthroscopic knee surgery, and specifically to a novel grasper-stitcher device which is intended to facilitate the surgical repair of torn anterior cruciate ligament tissue within the knee cavity. Also disclosed is a method for use of the device.
2. Brief Description of the Prior Art
With the advent of the arthroscope, surgeons have become able to view remotely located areas within the humand body, and therefore operate with fewer incisions, reduced surgical trauma and shorter recovery times.
Recent advantages in arthroscopic knee surgery have focused on the repair of torn meniscal cartilage within the knee cavity. For example, WHIPPLE et al., (U.S. Pat. No. 4,662,371), disclose a cutting-suctioning instrument for removing damaged meniscal cartilage during arthroscopic knee surgery. A pistol grip configuration linearly actuates an inner suction tube that has a distal end connected to a cutting jaw, at one end of an elongated tubular member. The tube serves as a suction passageway for the removal of the cut frgments of tissue. Hence, WHIPPLE et al., addresses rhe problem of remotely cutting damaged cartilage within a knee cavity, and removing fragments with a device that remains in situ for repeated cutting.
MULHOLLAN et al. (U.S. Pat. No. 4,621,640) demonstrate a mechanical needle carrier which can grasp and carry a small, curved surgical needle through a cannula, position the needle and set a stitch through torn meniscal cartilage, then release the needle and be withdrawn from the cannula. However, MULHOLLAN et al. do not address the problem of grasping the free end of acutely injured ligament, peripheral meniscus or even cartilage, to avoid neurovascular damage that might occur when needles are passed blindly, during athroscopic procedures.
STORZ (U.S. Pat. No. 4,607,620) illustrates a medical gripping instrument with an elongated tubular passage and a set of gripping arms, but an instrument configured to simply grasp tissue with the help of an endoscope.
None of these representative prior partents provide a suggestion that a grasper-stitcher as taught herein could be particularly valuable to perform a direct repair, arthrosscopically, by suturing a free end of torn anterior cruciate ligament (ACL) tissue within the knee cavity. Damage to the ACL is a common injury, especially among athletes such as skiers. A problem generally associated with prior art methods for arthroscopic repair of ACL tissue is the difficulty the surgeon encounters in attempting to simultaneously grasp and pass a surgical needle through the torn ACL tissue. A small surgical opening greatly limits his access to the location of the injury. As such, the surgeon is not free to insert one tool to hold and position the damaged tissue, and another to carry out the suturing of the ACL. It would therefore be extremely beneficial to have a surgical instrument which would allow a physician to simultaneously grasp and stitch damaged anterior crucitate ligament tissue within a remotely located knee cavity, under the limitations imposed by arthroscopic surgery.
The prevailing philosophy tody among knee surgeons is that primary repair alone of the anterior cruciate ligament is perhaps less than successful. Repair of a damaged mid substance ACL is still a major problem and has not been successful when done alone. The grasper-stitcher device of the present invention has its primary advantage in permitting a technique for repair of acutely injured ACL that will, it is believed, permit a repair that is sufficiently strong, and simulative of the original action of the ACL, so as to permit augmentation, as by the harvesting of a middle or lateral one-third of patella tendon.
There is definitely a place for arthroscopic repair of the ACL if this repair is backed up by a small extra-articular tenodesis of the iliotibial tract. The repair itself adds stability to the knee as a working unit. In those patients that are perhaps recreational athletes or manual laborers that need to minimize their rehabilitiation time, the present invention offers significant advantage. If the repair of the primary rupture of the ACL can be accomplished arthroscopically without painful arthrotomy incisions, stability is added to the extra-articular augmentation. In the population of 25 to 40 year old recreational athletes or sedentary individuals, an arthroscopic repair of ACL is definitely indicated.
In reviewing the literature there are basically two studies that report "successful" repair of the ACL. A series of articles by Marshall and Warren: Marshall, John L., D.V.M., M.D., F.A.C.S.; Warren, Russell, M.D., F.A.C.S., Wickiewicz, Thomas L., M.D.: Primary Surgical Treatment of Anterior Cruciate Ligament Lesions, The American Journal of Sports Medicine, Vol. 10, No. 2, 1982, 103-107; Warren, Russell F., M.D.: Primary Repair of the Anterior Cruciate Ligament, Clinical Orthopaedics and Related Research, No. 197, Jan-Feb, 1983, pp. 65-70) describe a multiple loop technique. An article by Odenstein, Suture of Fresh Ruptures of the Anterior Cruciate Ligament, ACTA OrthoP. Scand. 55, 270-276, 1984, describes how at least 7 nonabsorbable sutures can be utilized in a repair. Neither one of these techniques had the benefit of an extra-articular stabilizing procedure. The present procedure tends to minimize the stresses on the primary anterior cruciate repair, thus allowing healing to take place. Other studies in the literature, such as those by Feagin and Weaver, describe the use of only several stitches in the repair, but do not describe any type of extra-articular augmentation. According to applicant's procedure, a successful repair preferably comprises six to eight loops of nonabsorbable number 0 suture, and the device of the present invention greatly facilitates such repeated suture steps.